Home 9 Interviews 9 How to quantify the impact of the treatment protocol? – Valérie de Picciotto

Our team had the opportunity to talk with Valérie de Picciotto, equine veterinarian, about her first experience with EQUISYM. Discover through Arion’s story, how the system was used to establish the diagnosis but also to quantify the treatment results and implement deep longitudinal monitoring of the locomotion.

To have the results of the different evaluations, you can now download the data associated with this case study.

Can you please introduce yourself?

I am Valérie de Piciotto, an itinerant equine veterinarian, working in the North-West area of France, in two main sectors: Paris during the week and Pays de Loire during the weekends and school vacations. My activity is divided into three poles: medicine, dentistry – dental care and stomatology – and physiotherapy – sports performance and various pathologies.

As part of my activity, I was contacted by an amateur rider who owns an eight-year-old horse with amyotrophy of the right buttock. She was also concerned about the dental health of her horse, and the quality of the care he had previously received. We therefore examined these two elements.

1. Clinical examination of locomotion

After the first examination of the horse, what were your conclusions?

Initially, we did not find any significant defects in the mouth, except for a slight blockage of the right and left maxillary tables on the sixths, correlated with ramped mandibular bottoms. This implies bilateral mandibular retraction constraints with slightly reactive temporomandibular joints, a little tense and painful.

We began the locomotor examination in a classical way, with a first static examination in the stable, which revealed a wholly immobile but not painful back. Cervical pain was also reported, more marked in the lower cervical region on the right and in the middle cervical region on the left. The sacroiliacs were not very mobile on the other side of the rachis, and the left hindlimb was mobile in protraction but quite complicated to retract. In contrast, the situation was the opposite on the right hindlimb: a hindlimb that facilitated retraction but was resistant to protraction.

The first impression was that the pelvis was slightly rotated, with the left hip in front.

What about the dynamic examination?

We performed the dynamic examination afterwards, during which we used EQUISYM to quantify the locomotion of the horse. After positioning the sensors, we made the following classical clinical examination:

     Figure eight at the walk
    Circle at the walk – hard ground – both reins
    Circle at trot – hard ground – both reins
    Circle at trot and canter – soft ground – both reins
    Straight-line at the trot – back and forth
    Flexion of the four limbs 

For my part, I expected to see mostly a defect in the right hind locomotion, and I observed defects in engagement and propulsion. The main defect was the back immobility, coupled with a delay in the right hindlimb engagement on the left hand side – at the trot and at the canter – on soft ground, as well as a lower propulsion of the right hindlimb on the circles – soft ground especially. On hard ground, the horse still showed signs of discomfort, with the head easily out on the circles.

The EQUISYM data collected during the straight lines and flexions revealed a positivity of the right forelimb, I had some doubts during the examination, the horse being quite tense, head outside the circle, but I had not noticed any clear right forelimb lameness otherwise. This right forelimb asymmetry is really an element that EQUISYM revealed, in a very clear way. We were able to have an analytical reading of the vertical displacement of the horse’s different segments which highlighted the two dominant problems of this first examination: the right lateral.

After this diagnosis, what care was provided?

For the mouth, we did dental profiling, and for the locomotion, we did a global laser treatment. I have been using laser therapy for more than a year now with great interest, as it represents an alternative to the classic treatments that are offered to the articular system, such as infiltration for example. The laser also allows us to obtain interesting results in physiotherapy, without having to deal with the side effects of medication or risking periods of doping which can put horses at a disadvantage in their sporting performance.

The rider had also sent me the horse’s medical file, which showed a slight insertional desmitis of the right hindlimb suspensor, which had been treated with a local infiltration a year and a half earlier, and which had remained asymptomatic since.

We therefore provided comfort to the TMJ, the Hyoid bone, and the masseters, and focused on vertebral articular points. The horse received laser treatment of the interspinous spaces and the dorsal musculature, the sacroiliac and sacrococcygeal, and also at the insertion of the right hindlimb suspensor.


2. Treatment and longitudinal monitoring

What results have you seen?

We saw the horse again ten days later. The right forelimb flexion was no longer positive, although still slightly doubtful, but instead we had a strong positivity in the left forelimb. I assumed it was a degenerative problem because it was unusual for a young horse to have erratic positivity on the forelimbs.

As this horse was unshod and working barefoot, we asked a colleague to take front and side views of the feet. These revealed no abnormalities in the bone structure, but rather a defect of plumpness with a heel that was too high, putting too much pressure on the toe. We therefore proceeded with a slight trimming of the heels, to try to correct them. On the x-rays, by measuring the degrees of angle, I was able to conclude that the left front leg had a slightly higher angle than the right front leg, which has since been corrected.

The horse quickly improved in his footing according to his rider, but 48 hours later, she noticed that he was engorged, and worried about his locomotion.

And in the third session?

We saw the horse again for a third laser treatment. At this time, we performed an ultrasound of the tendons to ensure the condition of the tendon structures, especially the deep flexor, which may have been stressed due to the trimming. We did not find any abnormalities on that side. 

We therefore performed a laser treatment for tendon scarring, as a preventive measure, in addition to the usual laser treatment, with the exception of the back muscle points which were not done during this third session.

We then did a new examination with EQUISYM before the fourth session, where we could see that the improvement in back mobility was less noticeable than before the third session. The horse was less receptive to the treatment, probably due to the change in its posture and the absence of specific muscle care during the third laser session.

Have you observed any changes in the horse’s locomotion, especially when working?

After this examination, the horse went to show and his results were positive according to his sportive objectives. He behaved well, and by comparing the round with videos taken before the laser treatment, I could see a better overall functioning, especially on his back passage, as well as on his hindlimbs, which were much more articulated.

What were the next steps?

During the fifth consultation, we equipped the horse with EQUISYM again, in order to re-evaluate its locomotion in detail. We conducted a thorough examination, collecting all data, including flexion. Despite a persistent deficit on the right hindlimb, the data allowed us to observe improved locomotor symmetry. The two forelimbs flexions were negative, which is satisfying for me.


3. A first EQUISYM experience

Could you please tell us about your first EQUISYM impression?

EQUISYM really comes into its own in the finesse of the examination readings, because it is very complex to evaluate, with the naked eye, and to within a few millimeters, the load defect of a hindlimb between the two reins. In this particular case, with the naked eye, I underestimated the horse’s asymmetry, whereas EQUISYM clearly reveals it.

Regarding the physiotherapy care provided, I find it very pleasant to have a quantification of what we appear to see with the human eye. To use this young horse as an example, we can see an embryo of pelvic flexion in the evolution of passive back mobility and, to a lesser extent, active back mobility at the gallop. The horse is articulating much more as the back tension is reflected further forward towards the withers. During the clinical examinations, we could see him lowering his head more and more towards the ground, trotting for a long time with good back mobility, which he did not do before. It is true that with EQUISYM, and the quantified data, we can objectify the examinations, and communicate with the client, by showing him the evolution of the indices, and the symmetrization of the curves. The tool is both useful for diagnosis and educational for the owner.

What about the product’s use?

I am just starting with the product, but it is clear that it has been developed in an intuitive way, and it is an ergonomic tool for the horse: the protections are easy to put on, do not move and do not disturb the horse. It takes a little time to be familiar with the tool, and to adjust to placing the pelvis sensor.

The curve readings always seem very intelligible to me when I am accompanied, but I think that it also takes a learning period when you start alone. For that, there is the CSM service, and it is really very valuable to have a team that supports us in reading and analyzing the curves. It’s a great feeling to know that we are not alone with the tool, that a team is behind us to help us analyze the data. However, I think that we must be careful not to fall into hyper interpretation. I remain convinced that there is a degree of natural asymmetry in each horse that we cannot always overcome, and that it is not desirable to over-medicate and over-treat.

The benefit of longitudinal monitoring of a horse is to compare its own data, in relation to itself, or on the occurrence of an acute pathology or a notable gait dysmetry. In the context of longitudinal monitoring associated with performance physiotherapy, it is important to accumulate a number of examinations – and therefore data – to know the pattern of the horse, its own asymmetries. Because if we start taking all the X-rays as soon as a shift in a limb is perceived, I worry about a quick disappointment, and in the long run, an exhaustion of the clientele, who will have the impression of doing superfluous things. Indeed, some asymmetries can be linked to muscle fatigue, acidosis, …

To conclude, I think that EQUISYM is a real ally if it is used wisely, avoiding over-interpretation, and using it as a support for veterinary expertise.

Keywords: testimony, Valérie de Picciotto, locomotor examination, equine veterinarians, quantification of locomotion, equine locomotion, longitudinal monitoring, care, EQUISYM, CIRALE, EnvA